Is it polycystic ovary syndrome causing the hyperstimulation again?
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Female↗
Biomedical subjects
O Karabacak
Publications and source records attributed to O Karabacak.
Efficacy of transurethral electrovaporization of the prostate with respect to standard transurethral resection.
Transurethral electrovaporization of the prostate (TVP) has been introduced as an alternative to standard transurethral resection of the prostate (TURP) with lesser morbidity. However, the efficacy of this new technique has not been well known. To compare the results of standard TURP and TVP, 76 patients with symptomatic benign prostatic hyperplasia (BFH) were divided into two groups in a randomized clinical trial. Preoperative assessment included AUA Symptom score, maximum flow rates (Qmax), digital rectal examination, serum prostate specific antigen, and transrectal ultrasonography, with biopsy if the patient was randomized to vaporization. Transrectal temperature measurements and the hemoglobin concentration of the irrigation fluid were investigated in all the patients during the procedure. Although the transrectal temperature was higher in the TVP group (0.53-1.27 degrees C; mean 0.83 degrees C), no associated complication were determined. However, blood loss was significantly lesser than with TURP (340 mL v 60 mL). Two patients in the TURP group required blood transfusions, and one had sphincteric incontinence, whereas one postoperative retention, one reoperation with bladder perforation, and one sphincteric incontinence were seen in the TVP group. On the other hand, 12-month follow-up demonstrated that the uroflow rates improved in a similar manner. The Qmax increased in the TURP and TVP groups from 8.8 and 8.3 mL/sec to 19.6 and 17.2 mL/sec, respectively. The mean AUA Symptom Score decreased from 13.7 to 7.9 and 6.1 at 6 and 12 months, respectively. In the TVP group and from 14.6 to 7.3 and 7.0 at 6 and 12 months, respectively, in the TURP group. There were significant differences in the mean catheterization time (P < 0.0001) and hospital stay (P < 0.0001) in favor of TVP. Our results suggest that TVP is a safe and effective alternative treatment for symptomatic BPH.
Aged↗
The effects of human amniotic membrane and fibrin sealant in the prevention of postoperative adhesion formation in the rabbit ovary model.
The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4-5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1-0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p<0.001). Therefore, it can be concluded that fibrin sealant can be used as an adjuvant during reproductive surgery.
Animals↗
Small diameter versus conventional laparoscopy: a prospective, self-controlled study.
The objective of this study was to determine visual quality, diagnostic accuracy, and surgical merits of small diameter laparoscopy (SDL). Thirty-seven patients were randomly selected. The indications for laparoscopy were infertility, desire for tubal sterilization or chronic pelvic pain. Patients underwent SDL, followed by conventional laparoscopy (CL) as a control under general anaesthesia. Findings at operation were compared. The mean time for diagnostic work-up was longer with SDL than CL, 11.7 +/- 5.6 versus 7.6 +/- 3.2 min respectively (P < 0.04). Visual quality was scored from 4 to 1 by the operator; mean visual quality, mean endometriosis score and mean adnexal adhesions score were slightly lower with SDL than CL. Sensitivity of SDL in diagnosing endometriosis, adhesions, ovarian, uterine and pouch of Douglas lesions were 71, 58, 81, 89 and 73% respectively; specificity was 100, 96, 100, 100, 100% in the same order. Suction irrigation, cyst aspiration, tissue biopsies, simple adhesiolysis, tubal ligation and cauterization were easily performed with SDL. We conclude that SDL seems a good alternative to CL in diagnosing macro-pelvic anatomy and coarse pelvic pathologies and may also be good in performing surgical procedures such as: tubal ligation, biopsies and differential diagnosis of pelvic fluids. But SDL must be used cautiously in micro-oriented, functional conditions such as infertility, pelvic pain, endometriosis and adhesion scoring or treatment. SDL may be regarded as a less invasive but less sensitive tool with limited surgical merits.
Adult↗
The incidence of congenital malformations in a Turkish population.
OBJECTIVE: To determine the incidence and types of congenital anomalies in a Turkish population. METHOD: The total number of neonates (9160) born in the Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine during 1988-1995 were studied retrospectively. Newborns with congenital anomaly were identified from their birth registries. The total incidence, types and combined anomalies were determined. Also, the relationship between congenital anomalies and maternal age and/or gender were investigated. For statistical evaluation, Chi-square test, Yates correction and Fisher's exact tests were used where appropriate. RESULTS: The overall congenital anomaly incidence was 1.11% and the NTD incidence was 0.27% in our population. Anencephaly was the second most common NTDs with the ratio of 40%, following the spina bifida cases. There was a significant difference between female and male newborns with ancephalocele (P < 0.05). Urogenital system anomalies were found to be the second most common type of malformation with an incidence of 0.21%. Facial and musculoskeletal system abnormalities were the third and fourth most common malformations. Omphalocele incidence in our population was 5 in 9160 births and gastrochisis was 1 in 9160 births. CONCLUSION: The overall congenital anomaly incidence in newborns in our population is 1.11%. The most common malformations were CNS and urogenital abnormalities. NTDs incidence was 0.27% in a Turkish population.
Age Factors↗
An extraperitoneal burch procedure: a case report.
A new laparoscopic Burch procedure with preperitoneal balloon dissection is introduced. A stress incontinence case without cystocele was operated by laparoscopic extraperitoneal colposuspension. The procedure was found to be effective a year after and no complications were seen. The extraperitoneal Burch procedure has the advantages of easy dissection, less bleeding, pain, and adhesion formation, a lower chance of injury to intraperitoneal organs, and short hospital stay and operation time; but the procedure has the disadvantages of a new anatomy orientation and the additional cost of a disposable balloon dissection set.
Catheterization↗
Endometrial assessment by vaginal ultrasonography might reduce endometrial sampling in patients with postmenopausal bleeding: a prospective study.
The purpose of this study is to compare transvaginal sonographic endometrial assessment with histology obtained by endometrial curettage in postmenopausal patients and to determine a cut-off point for endometrial thickness to reduce unnecessary diagnostic curettage for postmenopausal bleeding. A total number of 289 postmenopausal women were studied prospectively; 192 patients with postmenopausal bleeding and 97 postmenopausal women without bleeding comprised the study and control groups respectively. All patients were scanned by ultrasound transvaginally, then dilatation and curettage was performed for endometrial evaluation. In all women with and without postmenopausal bleeding, endometrial thickness of 4 mm or less as depicted by sonography correlated well with 'atrophic endometrium' (100%). Of 158 women with an endometrium > 4 mm in both groups, 40 women (25.1%) had a negative result (tissue insufficient for diagnosis or atrophic endometrium), while 118 patients (74.8%) had a positive result which included proliferative and secretory endometrium, endometrial hyperplasia, polyps and cancer. As the endometrial thickness increased, the probability of finding pathology with curettage was increased linearly in postmenopausal bleeding (PMB) positive and negative groups and there was a significant linear positive correlation between PMB (+) and (-) cases (Linear regression, R = 0.91, p < 0.03). A significant difference was found between endometrium carcinoma and all other endometrial pathologies concerning the mean endometrial thickness of 22.7 +/- 10.2 mm (chi-square, p < 0.0001). Also, the mean endometrial thickness of 4.7 +/- 3.3 mm for atrophic endometrium and 6.1 +/- 3.7 mm for 'tissue insufficient for histological diagnosis' were found significantly different than all other endometrial pathologies (chi-square, p < 0.0001). Endometrial thickness of < or = 4 mm may serve as cut-off point for predicting pathology negative cases with an accuracy of 100% in postmenopausal bleeding positive and negative cases. Then as the endometrial thickness increases, the probability of finding endometrial pathology in curettage increases linearly with a positive predictive value of 74.6%.
Adult↗
The effects of 3-day clomiphene citrate treatment on endocrine and ovulatory responses.
A prospective cohort, paired clinical trial was carried out to test a shorter clomiphene citrate regimen of 3 days, measuring the endocrine outcomes and ovulatory responses. The trial took place at Gazi University Medical School Department of Obstetrics and Gynecology. The 28 infertile patients were newly accepted to the clinic with hypothalamopituitary disorder according to WHO classification Group II. They were treated with 50 mg/day clomiphene citrate (CC) for 3 days in 63 cycles. The control group of 28 paired patients were treated with 50 mg/day CC for 5 days in 40 cycles. The main outcome measures were: serum estradiol levels on day 11 (E-11), 14 (E-14) and postovulatory day 7 (E+ 7); serum progesterone levels on postovulatory day 7 (P+ 7); endometrial thickness on day 14 of the cycle; mean follicular phase length; and ovulation rates. The mean ages, gravidas, paritas, menstrual histories, E-11, P+ 7 levels, mean follicular phase length and luteal phase length were similar in both groups. E-14 (229.76 +/- 156.05 pg/ml vs. 338.25 +/- 350.60 pg/ml) and E+ 7 (217.30 +/- 114.95 pg/ml vs. 310.6 +/- 11.05 pg/ml) were significantly lower, whereas mean endometrial thickness on day 14 (10.30 +/- 1.39 mm vs. 9.52 +/- 1.96 mm) were significantly higher in the study group compared to controls (p < 0.05). Ovulation occurred in 82.53% of cycles in the study group and 95% in controls. In the study group, pregnancy was achieved in 17.3% of the ovulatory cycles; this rate was 10.5% in the control group. To decrease the peripheral antiestrogenic effects of CC, a regimen of 50 mg/day for 3 days may be used as a starting dose instead of the standard 5-day regimen.
Adult↗
[25 patients undergoing laparoscopy for pelvic pain].
25 patients have involved in this research, who have chronic gynecologic pelvic pain and each of them had normal gynecologic examination. Chronic pelvic pain has been found mostly between 30-39 years age group married, multipar females, associated with 44% dysmenorrhea, 36 p. cent dyspareunaie. Cultures and clinical examinations were all negative as a sign of infection. Experienced intra-abdominal operation or infection were causes of pelvic pain (48%), especially appendectomy has a prominent place (75%). Laparoscopic investigation showed: 16 p. cent adhesions, 28 p. cent chronic annexitis, 16 p. cent experienced pelvic inflammatory disease, 8 p. cent uterine leiomyoma, 4 p. cent each endometriosis, experienced parametritis and haemorrhagic lutein cysts. Instead of making group of lesions, we prefer to describe it, in numbers as infection importance coefficient (IIC), which is developed for this research. IIC 0-2 points presents insufficient organic causes, it does not represent the cause of pain. Non organic and non gynecologic reasons must be the cause of pain. Non organic and non gynecologic reasons must be investigated. IIC 3-5 points presents minor experienced intraabdominal infection. Secondary cases like myoma, ovarian cysts, chronic cervicitis should be considered first as reason. IIC 6 points and more presents direct organic deficiency suitable surgery is the treatment of choice of this group.
Adult↗
The epidemiology of neural tube defects in Izmir, Turkey.
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Anencephaly↗
Does ovulation induction affect the pregnancy rate after laparoscopic treatment of endometriosis?
OBJECTIVE: To determine the effectiveness of ovulation induction after laparoscopic treatment of endometriosis in an infertile population. DESIGN: An observational prospective study in which infertility cases were treated with laparoscopic surgery was followed up (mean 11 months), either by treatment (ovulation induction) or no further treatment (expectant management) and the outcomes recorded. In both groups pregnancies were compared by Cox's regression survival model. SETTING: Gazi University Hospital, Department of Obstetric and Gynecology, Ankara, Turkey. PATIENTS: Infertile women with different stages of endometriosis who were treated by laparoscopic surgery, with a mean duration of infertility of 80.7 (+/-50 [SD]) months. INTERVENTIONS: Patients were treated by cauterization of the foci, adhesiolysis, endometrioma stripping, and distal tubal reconstruction according to their lesions. Postoperatively, patients had either ovulation induction (clomiphene, hMG) therapy or no further treatment. MAIN OUTCOME MEASURE: Cumulative pregnancy rate of infertile women after laparoscopic treatment of endometriosis with or without ovulation induction. RESULTS: A total of 36 out of 128 patients became pregnant after laparoscopy, with a 34% cumulative pregnancy rate. In the ovulation induction group, relative risk (chance) of pregnancy was 1.42 (1.02-2.05, 95 % CI) when the duration of infertility was less than 5 years. In this lower risk group, the overall cumulative pregnancy rate was 46%--56% and 27% for the ovulation induction and expectant management groups, respectively. In the expectant management group, per cycle fecundity was 0.021, whereas it was 0.066 and 0.174 (p = 0.001) in the clomiphene citrate- and hMG-treated patients, respectively. Expectant management significantly increased the likelihood of pregnancy compared to ovulation induction in previous pregnancy, stage 1 or 2 endometriosis, and no male infertility groups (p = 0.04-0.009). CONCLUSION: After laparoscopic treatment of endometriosis, ovulation induction has a positive effect only if done with hMG and the duration of infertility was less than 5 years (P<.05).
Adult↗